Social Media in Care Delivery Tech Demo Day: Can doctors and nurses activate social networks to improve health?

if we combined the work of Nicholas Christakis, MD, and James Fowler, Ph.D, with integrated care delivery, what would it look like?

Put another way… If we we were successful in bringing health care teams to social networks (and vice versa) in a rational, helpful way, what would they actually do?

In recent weeks, I have written about linking social networks to personal health records (see: Coming to Social Media in Care Delivery Tech Demo Day: Linking social networks and personal health records) and quantative crowdsourcing (see: The case for linking quantitative crowdsourcing and care delivery : @CureTogether at Tech Demo Day) as technologies that will be featured in this event. This aspect of social media / social networking, championed most famously by Christakis and Fowler, is complementary to these approaches.

It’s the 3rd of 4 technologies coming on this day, represented by the team from Activate Networks (@mednetworks). I’ll write about the 4th (and last) technology next.

Activating social networks in health care – we still don’t know how to do it yet

I think it’s probably conventional wisdom that a person’s health is influenced by their individual actions as well as their environment and social milleu. Medical care, though, has not operated this way. As Christakis put it, in 2004, in the BMJ:

In the conventional perspective on medical care, the benefits and costs of health care are judged by the way in which they help to achieve a direct, intended outcome in a patient. However, since a patient is connected to others through social ties, health care delivered to one person, quite apart from its health effects on that person, may have health effects on others. The cumulative impact of the intervention is therefore a sum of the direct outcomes in the patient plus the collateral outcomes in others.

I identify with this because of my own personal experience practicing using an electronic health record with linked personal health record. I learned to type letters in the after visit summary to those people, for example. In my my own community, I began to recognize how a single person’s health (or death) could be so devastating (see: Photo: “She met every ambition she set out to conquer”).

And yet, we have not systematized this approach in primary care. Electronic Health Record systems are built on the premise of “one patient at a time.” They will get smarter over time, with our help.

What can social network analytics do?

If I knew with 100% certainty what the answer to this question was, we wouldn’t be having a technology demo day :). However, it is worth asking what it would be like if a physician and/or nurse had the ability to look at the population they are taking care of and see social clusters of people with care gaps or health issues that needed to be addressed. Given that the data shows that health professionals are (still) the #1 place that people go to get health information, the combination could be powerful.

Also, what about “collateral health effects” (as Christakis calls them) or health issues related to the ones of interest? What if, upon seeing the clustering of health behaviors in their community, care teams decided to physically walk the neighborhood, or develop programs or communication tailored to the issues that people and families worry about most (think: the unmentionables – see: “Sex, Money, and a Crappy Boss: The “unmentionable” stressors the healthcare industry can’t afford to ignore” )?

A quote from Centola, et. al (2010):

I predict that public health interventions aimed at the spread of new health behaviors (for instance, improved diet, regular exercise, condom use, or needle exchange)may do better to target clustered residential networks rather than the casual contact networks across which disease may spread very quickly (25)—particularly if the behaviors to be diffused are highly complex (for instance, because they are costly, difficult, or contravene existing norms).

Since primary care physicians (and I’ll say all physicians and nurses in an integrated care system) think holistically (person-centered rather than patient-centered), could this technology allow them to access their knowledge and expertise in innovative ways to solve health problems that we haven’t even thought of?

It’s definitely possible!

This is why the team from Activate Networks (note: they appear to be going through a rebranding, from “MedNetworks”), whose technology is based on based on methods developed by Professor Christakis and colleagues at Harvard University, have agreed to come and share at our technology demo day.

This isn’t social media/social networking in the form of discussion groups / friending people

This approach is an example of thinking about social networking in a different way than the classic “patients friending doctors” (which I don’t think will be successful in the long run) or “online discussion communities.” I think this is important because it helps people understand that (okay, I’m going to quote our own paper…):

Social networking is not a program or a Web site; it is a community of people who share similar interests and activities who interact through online and mobile technologies.

What all of these things have in common is the “community of people” rather than the technology that brings them together, which I think is the ultimate draw for doctors (all specialties), nurses, and all care providers everywhere.

Homophily vs. Contagion? Yes.

I’ve decided that this topic is out of scope for this blog post (it’s too long already) and probably for the tech demo also. If you are in this field and these terms mean something to you, feel free to review some of the references below, or add a comment to this post with your thoughts.

Since this field has multiple peer-reviewed publications attached to it, I’m attaching links to them below if you’d like to read more.


Ted Eytan, MD